Is the Mind Part of the Body? The Challenge of Integrating Behavioral Health and Primary Care in a Reform Era

Friday, May 2, 2014

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As more people gain coverage that includes behavioral health benefits, and given a limited supply of mental health professionals, analysts and advocates are raising concerns over how and whether new laws and regulations will be able to change that situation. One option being explored in many settings is the integration of behavioral health services with primary care. There is early evidence that coordinating care in this manner may deliver high-quality care more efficiently.

For almost 20 years, bipartisan majorities in Congress have been legislating ways of bringing behavioral health services to the 62 million Americans in need of them. Beginning with the 1996 Mental Health Parity Act, Congress has steadily broadened access to these services.

All state Medicaid programs and plans sold on the health insurance marketplaces cover behavioral health services. Yet 60 percent of adults and 70 percent of children with a mental health disorder do not receive treatment. In children, the average time between onset and treatment of mental illness is nine years. And one in six adults has co-morbid mental health and medical conditions. More commonly their medical condition is being treated while their mental health condition goes undiagnosed and untreated.

Do current models of integrating behavioral and physical health hold promise? Are there enough providers to meet the demand of the newly insured? What is needed to help primary care fill the gap? How are states meeting the budgetary challenge in Medicaid programs? Is parity a reality?

A distinguished panel of experts addressed these and related questions.

Michael Hogan, former commissioner of the New York State Office of Mental Health, and chairman of President George W. Bush’s New Freedom Commission on Mental Health, provided a big picture overview of the status of behavioral health integration with medical care, and the impact on state Medicaid programs.

Laurel M. Newman, quality implementation manager, Primary Care Clinical Program at Intermountain Healthcare, focused on initiatives and models that are working, and the challenges facing those who are implementing or hope to implement these models.

Nick Macchione, director of the San Diego County Health and Human Services Agency, highlighted the special challenges of serving the mental health needs of a very diverse population and of running an accredited psychiatric hospital in an environment of change.